Amanda Rowe, Doug Gardner, Pat Patterson, Lisa Belanger



NASBHC leadership call

Media and policy response to reproductive health care

November 6, 2007

12-1:30 pm EST

Invited attendees: Board of directors, technical assistance and training panel, evaluation and quality panel, government affairs committee, state association executive directors, and funders.

Local activity in Portland, ME

Amanda Rowe, Doug Gardner, Pat Patterson, Lisa Belanger

History:

SBHCs in Portland, ME, have been in operation since the mid 90s operating in seven schools today . In 2002 the school committee (school board) approved reproductive health services for 3 schools—2 high schools and an alternative school with no opposition.

Current:

In response to increased sexual activity in middle schools, the staff and advisory committee decided to talk to the school nurse and principal to move forward on providing contraception. The superintendent approved and sent the proposal to the school committee. The day before the committee meeting (October 17) we got a call from the local paper, which led to national media at the school committee meeting.

The press coverage was bigger nationally than in Portland. The process in Portland was balanced with support from parents, school committee members, and the health care provider community.

There is a school committee meeting Wednesday night. Opposition will turn out at it, as well as the media. We are prepared with speakers.

A conservative legal group from DC is threatening a lawsuit. It is a scare tactic with little ground, for example most of the footnotes come from newspaper articles.

There are many opinions on the interpretation of reporting the age of consent laws. This issue has been sent to the Attorney General’s office.

Abigail English, from the Center for Adolescent Health and the Law referenced a joint policy statement from AAP, ACOG, SAM, AMA. It is a very complex issue and they collide at times.

Our response is that center will abide by the law however we want to provide a full scope of services.

Links to statements:

From Guttmacher:

Fact sheet on Minors’ Consent Laws -

Minors’ Access to Contraceptive Services -

From AAP:

Policy Statement on Adolescents and Contraception -

Joint Policy Statement on Adolescents and Confidentiality -

From SAM:

Access to Health Care for Adolescents [pic]

Protecting Adolescents: Ensuring Access to Care and Reporting Sexual Activity and Abuse [pic]

Reproductive Health Care for Adolescents [pic]

School-Based Health Clinics [pic]

From 2007 NASBHC Convention:

Workshop by Katy Duffy of Physicians for Reproductive Choice in Health () focused on provider aspect of issue. Available on convention CD-Rom

National Media

The national media covered this issue in over 65 outlets, including NY Times, CNN, Fox News, Good Morning America, the Today Show, NPR, etc.. The AP article was picked up by an additional 20 outlets.

To questions/concerns from the media were:

How many middle schools providing birth control?

Parental involvement

Are schools the right place to provide these services?

Last week the AP conducted a poll that determined over 60% of Americans support Portland’s decision. This was picked up by 26 outlets, including TV media.

There are indications that national media are still planning to attend the meeting tomorrow night.

Please contact us if you hear from national media or folks from major media markets. We need to keep the messaging consistent to protect all SBHCs and federal legislation.

Please send clips and TV segments to us.

Hill Activity

At first we were concerned and optimistic that there would be no damage. Within a few days, two Republican senators introduced seven amendments that would have effectively eradicated all federal funding for schools providing any form of contraception. We worked with the pro-Choice community to fight the amendments. A deal was struck when a Dem retracted his amendment. Seven of the 12 anti-choice amendments would have impacted SBHCs.

These amendments raised the attention of others who may not have otherwise noticed.

The timing was bad because S600 was being discussed in the HELP committee that week. Intelligence tells us that we have not made friends, and we have potentially not gained any enemies. The HELP committee is discussing S600 again on Wednesday. We offered a briefing to the HELP committee staff, because we don’t want to hide behind this issue. We decided to not to host a briefing because of the pace of decision making on the Hill.

We are working to introduce the House bill. Some staff have not heard anything about this issue. We hope to secure a R co-sponsor by tomorrow. They hoped to introduce this week, but in light of potential press in Maine this week, they will hold off until next week. Once the bill is introduced we will send out a call to action to get co-sponsors on the bill.

The Hill staff with whom we have talked indicated that consent and confidentiality issues will come up soon. We have framed our response around local control and local input, but we think that is falling short. It is leaving some hill staff thinking that we don’t have to abide by the existing laws.

We are prepared for the worst kinds of amendments to come our way. The past amendments are an indicator.

State and Legal Issues

Services in SBHCs have been questioned regarding their adherence to state laws and standards. Laws vary from state to state. Below are some key points to consider regarding minor consent and child abuse reporting laws.

1. Minor consent laws:

If the state law allows minor consent for services, in most cases, confidentiality of care is assumed. There are exceptions, so check with your state. Often there are also independent confidentiality of medical care and records laws. It is important to determine the situation for your state. Confidentiality can always be overridden if there is a risk to the well-being and lives of the patient and/or others.

There are a few states that have statute clarifying care in a SBHC. Please be sure to look into them too.

2. Child Abuse Reporting laws:

In general health providers are not required to report all illegal activity under criminal law, however they are required to report all instances of child/ sexual abuse in accordance to their state laws.

These two areas of the law have been highlighted as you have heard previously in this conversation. We encourage you to research the legal statutes in your state. It is important that the SBHCs in your state are aware of the state laws.

To learn more about the laws and interpretations of laws in your state, please contact and partner with organizations that work on these issues, such as Planned Parenthood, teen pregnancy organizations and other community health groups. They are the experts in your area. We anticipate some Congressional staff may be asking questions and media may become interested. Of course, it is always best to be prepared and knowledgeable.

NASBHC Position

NASBHC’s response has been support of local control. We don’t feel that is supportive of communities providing the care and not consistent with what we believe.

We are re-opening up our position on SBHC and reproductive health and confidentiality to be in line with other national provider organizations. Our position will be grounded in professional standards of care. We will get back to you with our position once it is reviewed and approved by the board.

Please refer to the second page of the talking points handout.

Regarding publication of names of SBHCs: NASBHC does not share the names and contact information of SBHCs with anyone other than the state associations. This protects the centers from potential conservative inquiries, media and marketing. The state associations can choose to make the public and we ask them to consider pros and cons when doing so.

Questions

Illinois:

There is concern that activity in Maine could jeopardize the strong state confidentiality laws in the state.

Suggestions: work with partners, inform communities of the potential challenges, learn about the services and local regulations, and communicate with NASBHC at all times.

Colorado

There was a front page article in Denver Post to provide services in six high schools. They scrambled to get the information needed to respond. There is a request for NASBHC’s support to develop a local statement.

Oregon

Congressional staff have called centers and the Network. The Network has been asked not to provide the information on the individual sites. There is also the challenge that the health department answers to a larger PR department. Anytime they are involved in any kind of media decisions, someone higher up decides who, what, when, where. School based health centers need to talk for themselves.

Suggestions: Identify press contacts in the communities. We need to make sure we can provide them with something. We can provide resources and support to assist the local press contacts.

West Virginia/ New Mexico/ Oregon:

The Maine Medicaid office called inquiring about the reimbursement policies for reproductive health services in their states. Linda shared the aggregate data from the census with Richard to give to the Maine Medicaid office. The AAP position on coverage and reimbursement is supportive statement.

Miami, FL

The local health department convened to find out which SBHCs are providing family planning services. They are meeting again. They are asking for information. We will give them aggregate data, not specific to sites. NASBHC can strategize to help out on this.

Lewiston, ME

They had a scheduled school committee meeting. They don’t provide the full range of services and the media coverage spun that they were proud of it.

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